Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis
Background and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic re...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-10-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/12/11/2434 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850145624792498176 |
|---|---|
| author | Andrei Ovidiu Olteanu Artsiom Klimko Eugen Nicolae Tieranu Andreea Daniela Bota Carmen Monica Preda Ioana Tieranu Christopher Pavel Mihai Radu Pahomeanu Cristian Valentin Toma Adrian Saftoiu Elena Mirela Ionescu Cristian George Tieranu |
| author_facet | Andrei Ovidiu Olteanu Artsiom Klimko Eugen Nicolae Tieranu Andreea Daniela Bota Carmen Monica Preda Ioana Tieranu Christopher Pavel Mihai Radu Pahomeanu Cristian Valentin Toma Adrian Saftoiu Elena Mirela Ionescu Cristian George Tieranu |
| author_sort | Andrei Ovidiu Olteanu |
| collection | DOAJ |
| description | Background and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn’s disease. Methods: A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn’s disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. Results: Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn’s disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. Conclusions: Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn’s disease. |
| format | Article |
| id | doaj-art-14bd08adee424ef0b543cf4bc3749a3c |
| institution | OA Journals |
| issn | 2227-9059 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj-art-14bd08adee424ef0b543cf4bc3749a3c2025-08-20T02:28:02ZengMDPI AGBiomedicines2227-90592024-10-011211243410.3390/biomedicines12112434Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-AnalysisAndrei Ovidiu Olteanu0Artsiom Klimko1Eugen Nicolae Tieranu2Andreea Daniela Bota3Carmen Monica Preda4Ioana Tieranu5Christopher Pavel6Mihai Radu Pahomeanu7Cristian Valentin Toma8Adrian Saftoiu9Elena Mirela Ionescu10Cristian George Tieranu11Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaLaboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, 8091 Zurich, SwitzerlandDepartment of Cardiology, University of Medicine and Pharmacy, 200349 Craiova, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Pediatrics, “Marie Sklodowska Curie” Children Emergency Hospital, 077120 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Innovation and e-Health, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaBackground and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn’s disease. Methods: A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn’s disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. Results: Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn’s disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. Conclusions: Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn’s disease.https://www.mdpi.com/2227-9059/12/11/2434postoperative recurrenceCrohn’s diseasebiologic therapyinfliximabustekinumabazathioprine |
| spellingShingle | Andrei Ovidiu Olteanu Artsiom Klimko Eugen Nicolae Tieranu Andreea Daniela Bota Carmen Monica Preda Ioana Tieranu Christopher Pavel Mihai Radu Pahomeanu Cristian Valentin Toma Adrian Saftoiu Elena Mirela Ionescu Cristian George Tieranu Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis Biomedicines postoperative recurrence Crohn’s disease biologic therapy infliximab ustekinumab azathioprine |
| title | Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis |
| title_full | Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis |
| title_fullStr | Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis |
| title_full_unstemmed | Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis |
| title_short | Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis |
| title_sort | managing crohn s disease postoperative recurrence beyond prophylaxis a comprehensive review with meta analysis |
| topic | postoperative recurrence Crohn’s disease biologic therapy infliximab ustekinumab azathioprine |
| url | https://www.mdpi.com/2227-9059/12/11/2434 |
| work_keys_str_mv | AT andreiovidiuolteanu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT artsiomklimko managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT eugennicolaetieranu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT andreeadanielabota managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT carmenmonicapreda managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT ioanatieranu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT christopherpavel managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT mihairadupahomeanu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT cristianvalentintoma managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT adriansaftoiu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT elenamirelaionescu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis AT cristiangeorgetieranu managingcrohnsdiseasepostoperativerecurrencebeyondprophylaxisacomprehensivereviewwithmetaanalysis |